Provider Demographics
NPI:1063441285
Name:BALA MEDICAL ASSOCIATES P.C.
Entity type:Organization
Organization Name:BALA MEDICAL ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-667-1115
Mailing Address - Street 1:2 BALA PLZ
Mailing Address - Street 2:SUITE PL-8
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1501
Mailing Address - Country:US
Mailing Address - Phone:610-667-1115
Mailing Address - Fax:
Practice Address - Street 1:2 BALA PLZ
Practice Address - Street 2:SUITE PL-8
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1501
Practice Address - Country:US
Practice Address - Phone:610-667-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044717L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA382566OtherHIGHMARK BLUE SHIELD
PACH4260OtherRAILROAD MEDICARE
PA0346759001OtherINDEPENDENCE BLUE CROSS
PA065371Medicare ID - Type Unspecified
PA0346759001OtherINDEPENDENCE BLUE CROSS